Provider Demographics
NPI:1336477512
Name:TIMOTHY A GLEASON DC
Entity Type:Organization
Organization Name:TIMOTHY A GLEASON DC
Other - Org Name:GLEASON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-725-5005
Mailing Address - Street 1:840 W OLIVE AVE
Mailing Address - Street 2:STE. D
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2421
Mailing Address - Country:US
Mailing Address - Phone:209-725-5005
Mailing Address - Fax:209-725-3020
Practice Address - Street 1:840 W OLIVE AVE
Practice Address - Street 2:STE. D
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2421
Practice Address - Country:US
Practice Address - Phone:209-725-5005
Practice Address - Fax:209-725-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0226850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU47578Medicare UPIN